Cystosarcoma phyllodes in young women

A total of eight cases of cystosarcoma phyllodes in women under 25 years of age were reported to the Swedish Cancer Registry during a ten-year period (1960 to 1969). Only one of these tumors was malignant. It was successfully treated with simple mastectomy and postoperative radiation therapy. Of the remaining seven cases, six were treated with local excision of the lesion and one with simple mastectomy. In no case, did the tumor recur during a follow-up of an average of ten years. Local excision seems to be sufficient for the benign form of the tumor, whereas simple mastectomy is indicated for the malignant form. Radical mastectomy is indicated only of the tumor has invaded the pectoral fascia. The tumor rarely metastasizes to the axillary lymph nodes.

Cystosarcoma phyllodes: a clinicopathologic analysis of 42 cases

A retrospective clinicopathologic evaluation of 42 patients with cystosarcoma phyllodes was undertaken to determine if tumor size, contour, degree of stromal atypia and mitotic activity were reliable indicators of clinical behavior. Excluding size, the latter three determinants showed a positive correlation with prognosis and served as the basis of a classification in which 18 benign, 5 borderline and 19 malignant cystosarcomas were diagnosed. The tumors occurred in women averaging 44.3 years of age who most often presented with a palpable occasionally painful mass with a median diameter of 5 cm. Excision or simple mastectomy were the more frequent forms of therapy. Local recurrences were experienced by 6 patients and occurred in all 3 categories of tumor. Only malignant neoplasms developed systemic metastases which was observed in 4 patients 3 of which have died. On borderline tumor recurred 14 times and eventually proved fatal as a result of contiguous pulmonary involvement. A plea is made to label the stroma of malignant cystosarcomas as to the cell(s) of origin so future investigators may evaluate the effect of various soft tissue patterns on prognosis.

Cystosarcoma phyllodes

Recurrence and metastases of a cystosarcoma phyllodes are poorly correlated with the histologic type and treatment used. There is some evidence, however, that the prognosis is more favorable for small tumors and minimal cellular atypism. Local excision seems to be associated with a higher incidence of recurrence of the tumor. Metastases can develop later from what appears primarily a benign, as well as a malignant, type. Mastectomy as primary treatment was not always effective in preventing the local recurrence of the tumor. If the tumor recurred after mastectomy, it gave rise to fatal metastases. The recurrence of the tumor after local excision is secondary to microscopic foci retained after enucleation. If a local excision is done, it should include a wide margin of mammary tissue around the tumor. Wide local excision, for small, slow growing and clinically benign tumors can be used as a first operation, with wider re-excision and later mastectomy if the tumor recurs. Large and rapidly growing tumors that suggest malignant disease should be treated primarily by mastectomy.

[Pathogenesis, morphology, prognosis, clinical course and therapy of cystosarcoma phyllodes mammae (author's transl)]

Our investigation of 20 cases of C. ph. of the breast in women aged between 12 and 70 years yielded the following results: 1. In all cases a fibroadenoma or remnants of such a tumor were seen alongside with C. ph. A C. ph. therefore always develops on the base of a benign fibroadenoma of the breast. 2. The mitotic proliferation of the epithelium induces a proliferation of the myoepithelial cells which form the stromal portion of the tumor and can differentiate in to fibroblasts, lipoblasts, smooth muscle cells, reticulum cells, cartilage cells, osteoid cells or bone cells. The C. ph. of the female breast should thus be seen as an adenomyothelioma. Malignant degeneration of stromal cells possibly with haematogenous metastasis is observed in some cases. Concurrent malignant change of the epithelium (carcinosarcoma) is extremely rare and leads to lymph node metastases. 3. At the time being, there is no standardized and/or schematic treatment available. The therapy should be performed according to the size and growth of the tumor into the surrounding tissue, from simple excision to mastectomy. Radiation therapy ist not effective.

Clinical course of cystosarcoma phyllodes related to histologic appearance

A series of 17 females having cystosarcoma phyllodes underwent surgical treatment. The subsequent clinical course was observed periodically. Twelve patients had originally histologically benign tumors. Six patients had a recurrence, and of these, malignant characteristics developed in four instances. Five patients had originally histologically malignant tumors. Recurrences were encountered in four. Five patients died from a generalized spread of the tumor. Three of these patients had originally histologically benign tumors, in which malignant features of the recurrent tumor subsequently developed. The surgical treatment ranged from local excision to simple mastectomy with additional roentgenotherapy in three. Neither procedure prevented a recurrence from the original tumor, whether benign or malignant. Poor correlation exists between biologic behavior and histologic appearance of cystosarcoma phyllodes, independent of the surgical procedure. Wide local excision in histologically benign and mastectomy in histologically malignant tumors are advised, but no final decision could be reached. It is proposed to restrict ther term cystosarcoma phyllodes to histologically malignant tumors and use the term fibroadenoma phyllodes in instances of histologically benign tumors.

Metastatic malignancy of the hand

Metastatic malignancies of the hand are infrequent and seldom initially diagnosed and often taken for infections. They usually occur at the late stage of metastatic generalization and indicate an ominous prognosis and justify surgical amputation. A case of metastasis to the distal phalanx of the left ring finger of a woman who had undergone radical mastectomy for breast cystosarcoma phylloides is reported. The evolution of this lesion, initially taken for a whitlow, lasted 45 days and eventually was treated by amputation. A review of literature confirms the rarity of the lesion, and reveals the pathological, clinical and radiographic characteristics.

Mixed tumor of female breast of unusual duration and size

A 72-year-old black woman presented with huge enlargement of the right breast beginning approximately 30 years earlier and progressively enlarging over the years. The breast was stony hard, painless, and inconvenient only because of size and weight. Simple mastectomy was done and pathologic examination showed a benign mixed tumor with large areas of pseudocartilage, osteoid, and bone formation. Preoperatively the serum calcium was 11.0 mg/100 ml and alkaline phosphatase, 550 mU/ml (SMA-12). Postoperative course was uneventful and within several weeks the alkaline phosphatase fell to a normal range (35-115 mU/ml). The case presented requires little comment other than its unusual nature and duration. Extensive bone formation was undoubtedly responsible for the elevated alkaline phosphatase and, as expected, it returned to normal limits following excision of the tumor. Simple mastectomy is considered the treatment of choice.

Radical treatment of recurrent cytosarcoma phylloides

Malignant cystosarcoma phylloides is a rare breast cancer which frequently recurs locally before metastasizing. Local recurrence of cystosarcoma phylloides is unlike adenocarcinoma of the breast since it does not necessarily indicate systemic metastases; and, therefore, aggressive surgery can cure a number of patients with locally recurrent tumor. The present report is an extreme example of a patient with locally recurrent malignant cystosarcoma phylloides, and it illustrates the value of radical surgery in controlling this disease which had previously recurred 21 times. Fifteen months following sternal resection, the patient enjoys her longest tumor-free interval in 16 years.

Giant fibro-adenoma (cystosarcoma phyllodes) in adolescent females--a clinicopathological study

1. An analysis of the findings in a series of 25 cases of giant fibro-adenoma of the breast in adolescent females is presented together with a review of the relevant literature. The clinical features, histology, prognosis and treatment of these tumours are discussed.

2. Follow-up of from 2 to 8 years after total excision of the tumours has shown that normal breast development occurred in all the cases. There was no recurrence or distant metastasis.

3. Despite clinical features and histological characteristics suggestive of malignancy the tumour has been found in our experience to be strictly benign in patients under the age of 20 years.